Mental Health Link for Veterans Referred to Mental Health Services (MHL)
Mental Health Link: Text Based Support for Veterans Waiting to Initiate Mental Health Services for Depression
Overview:
Depression is common among Veterans. About 1 in 6 Veterans experiences depression at any given time, and about half may experience it during their lifetime. Without treatment, depression can contribute to substance use, poor health, suicide, and early death. However, many people delay or do not receive treatment. Fewer than one-third of Veterans with depression use psychotherapy. Although the VA is working to improve access to mental health care, staffing shortages can lead to long wait times. These waiting periods may provide an opportunity to support Veterans and help them prepare for treatment.
Mental Health Link:
The research team developed Mental Health Link (MHL), a text-based process that supports Veterans while they wait for mental health services. MHL helps patients better understand their emotions and symptoms and offers simple coping strategies they can use right away while waiting.
Study Goals:
The study will examine whether MHL helps Veterans during the wait period and with treatment engagement. The study will also ask Veterans and providers about what helps or prevents MHL from being used in routine care.
Study Design:
Over five years, the study will compare MHL with usual care at three VA sites. It will include 192 Veterans referred to psychotherapy for depression. The results will show whether MHL improves participation in treatment and helps Veterans while they wait for services.
In the future, these findings may help the VA expand MHL and other effective mental health and suicide-prevention services.
研究概览
详细说明
Background: Depression is one of the most prevalent mental health concerns among Veterans. Nearly 1 in 6 Veterans has the disorder at any given time and 50% of Veterans meet criteria for depression at some point in their lives. Depression is associated with significant adverse outcomes, and untreated can result in drug abuse, poor health outcomes, suicide and other-cause mortality. Adults with depression often delay and underutilize treatment, and such delays in care are associated with low treatment utilization.
Significance: Psychotherapy utilization rates for depression among Veterans over the past two decades have stayed below 34%. VHA has organizational priorities to decrease system barriers through various strategies. Despite these efforts, the VHA has a critical national staffing shortage. Fortunately, mental health visit wait times can be leveraged as an opportune moment to support and prepare Veteran patients for upcoming visits. Currently, there are no tools to provide support to Veterans while they wait for mental health services.
Innovation and Impact: To address this gap in care, our team developed and pilot-tested Mental Health Link (MHL),an innovative solution that does not rely on reducing wait times, but rather leverages wait times to provide support and prepare Veterans for care. MHL is a semi-autonomous text-based tool designed to improve emotional and symptom awareness, and provide support during wait periods through sharing easy to implement coping strategies.
Specific Aims. Aim 1: Determine the effect of MHL on psychotherapy initiation and adherence (number of sessions completed). Aim 2: Determine the effect of MHL on emotional awareness, a sense of connectedness, and satisfaction with the VA and mental health service. Aim 3: Identify determinants, strategies, and perceived outcomes in a subsample of MHL users (n = 24) and their providers (n = 24) to inform an implementation research logic model and intervention mapping.
Methodology: The investigators propose a 3-site, 5-year mixed-method hybrid I randomized control trial (RCT) using an altered Zelen design to compare MHL to usual care in a sample of Veterans (N = 192) referred to psychotherapy for depression. In Aim 1, the investigators will employ logistic regression and poison regression to estimate the difference between the intervention and control groups in treatment initiation rates and number of sessions (i.e., treatment adherence), respectively. In Aim 2, the investigators will employ repeated measures MANCOVAs to test for the interaction between time and group on proposed outcomes: positive and negative emotional awareness, sense of connectedness and satisfaction. For Aim 3 the investigators will use a qualitative matrix-analysis framework to analyze focus group data to identify other factors related to Aims 1 and 2 outcomes for triangulation and key determinants of implementation of MHL into clinical flow. Next Steps/Implementation. By identifying determinants of implementation the investigators will target facilitators and barriers to integrate MHL into the mental health service workflow. This work will also provide evidence of effectiveness outcomes. Overall, findings will facilitate the development of a follow-up Merit, Type II Hybrid RCT, focused on implementation and effectiveness outcomes. In the long-term, this work will support the implementation and sustainment of evidence-based mental health and suicide prevention practices by optimizing access to care, using value-based care systems.
研究类型
注册 (估计的)
阶段
- 不适用
联系人和位置
学习联系方式
- 姓名：Vanessa Panaite, PhD
- 电话号码：(813) 768-2193
- 邮箱：vanessa.panaite2@va.gov
研究联系人备份
- 姓名：Lisa M Ballistrea, MPT DPT BS
- 电话号码：(813) 558-7637
- 邮箱：Lisa.Ballistrea@va.gov
学习地点
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Colorado
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Aurora、Colorado、美国、80045-7211
- Rocky Mountain Regional VA Medical Center, Aurora, CO
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接触：
- Christine Melillo, PhD
- 邮箱：Christine.Melillo@va.gov
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Florida
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Tampa、Florida、美国、33612
- James A. Haley Veterans' Hospital, Tampa, FL
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接触：
- Shannon Miles, PhD
- 邮箱：Shannon.Miles@va.gov
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Illinois
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Hines、Illinois、美国、60141-3030
- Edward Hines Jr. VA Hospital, Hines, IL
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首席研究员：
- Vanessa Panaite, PhD
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接触：
- Julie F McMahon-Grenz, MS BS
- 电话号码：(813) 339-3050
- 邮箱：Julie.McMahon-Grenz@va.gov
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参与标准
资格标准
适合学习的年龄
接受健康志愿者
有资格学习的性别
描述
Inclusion Criteria:
-Veterans who receive a referral to psychotherapy for depression in a specialty care clinic (i.e., Mental Health Clinic at the VA or through VA Community Care)
Exclusion Criteria:
- Have current suicidal ideation with intent of self-harm in the last week
- Have current homicidal ideation with plans to hurt a specific person or have a clinical flag for disruptive behavior in their chart
- Have visual impairment that will impact completion of self-reports
- Have current diagnoses of bipolar disorders, psychotic disorders, memory and cognitive disorders
- Have referrals only to psychiatry or to a substance use disorder clinic
- Are hospitalized, in order to focus on their intensive care
学习计划
研究是如何设计的？
设计细节
- 主要用途：治疗
- 分配：随机化
- 介入模型：并行分配
- 屏蔽：无（打开标签）
武器和干预
参与者组/臂 |
干预/治疗 |
|---|---|
|
实验性的：Mental Health Link (MHL)
Participants receive the fully automated MHL intervention through VA Qualtrics while awaiting their first specialty mental health appointment. Following the baseline survey, a welcome text activates twice-weekly check-ins and twice-weekly support messages until two days before the appointment. Check-ins collect patient-generated feedback on mood, PHQ-8 symptoms, daily event appraisals, emotions, and emotion intensity. Participants may skip any task. Support messages provide practical coping strategies. PHQ-8 scores ≥15 or heightened negative emotions trigger automated messages with contact information for the participant's existing care providers, the Veterans Crisis Line (call, chat, or text), and 911. At completion, a data manager prepares a summary of check-in data, uploads it to the medical chart, and alerts the participant's providers. |
Mental Health Link (MHL) is a text-based process that supports Veterans with depression while they wait to begin mental health care. Twice a week, it helps Veterans check in on daily events, emotions, and depression symptoms while offering brief, practical coping strategies based on evidence-based therapies, including cognitive behavioral therapy, behavioral activation, and acceptance and commitment therapy. MHL was tailored with input from Veterans to improve emotional awareness and monitor changes in symptoms. |
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无干预：Usual Care Control
Veterans assigned to this control arm receive usual care while awaiting their initial specialty mental health appointment. They may passively wait or receive psychiatric care or brief supportive psychotherapy through primary care. Half of the Veterans randomized to usual care will be invited to join an observational study examining their experiences with and use of mental health services. These participants will complete baseline and exit surveys to improve prediction and understanding of treatment initiation and utilization, because medical chart data alone have not produced robust predictive models. All study procedures are conducted for research purposes only, although the procedures and measures are similar to those used in standard mental health care. |
研究衡量的是什么？
主要结果指标
结果测量 |
措施说明 |
大体时间 |
|---|---|---|
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Effectiveness of Intervention as Assessed by Rate of Depression Treatment Initiation
大体时间：An average of 30 weeks
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The investigators will evaluate % mental health treatment initiation relative to the control arm. Treatment initiation is defined as initial mental health appointment being completed. |
An average of 30 weeks
|
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Effectiveness of Intervention as Assessed by Rate of Depression Treatment Adherence
大体时间：An average of 30 weeks
|
The investigators will evaluate number of mental health treatment sessions completed relative to the control arm. Treatment adherence is defined as continuing treatment past initiation. |
An average of 30 weeks
|
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Emotional Awareness
大体时间：An average of 30 weeks
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Emotional awareness will be derived based on statistical modeling. |
An average of 30 weeks
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Social Connectedness Scale
大体时间：Week 1 and an average of 30 weeks
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Sense of Connectedness. On a scale from 0-10, how connected do you feel to the mental health service at your VA? Please write about your experience with Mental Health Link (MHL) that may have affected your sense of connectedness to the VA mental health service. |
Week 1 and an average of 30 weeks
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Client Satisfaction Questionnaire
大体时间：Week 1 and an average of 30 weeks
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Satisfaction with services. The Client Satisfaction Questionnaire consists of eight items, each rated on a 4-point Likert scale ranging from negative to positive responses (e.g., 1 = none of my needs met, 4 = almost all of my needs met). |
Week 1 and an average of 30 weeks
|
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Barriers and Facilitators of Mental Health Link (MHL) Future Implementation
大体时间：An average of 30 weeks
|
Barriers and facilitators of Mental Health Link (MHL) future implementation will be assessed through qualitative interviews with Veterans and mental health providers. |
An average of 30 weeks
|
合作者和调查者
调查人员
- 首席研究员：Vanessa Panaite, PhD、Edward Hines Jr. VA Hospital, Hines, IL
研究记录日期
研究主要日期
学习开始 (估计的)
初级完成 (估计的)
研究完成 (估计的)
研究注册日期
首次提交
首先提交符合 QC 标准的
首次发布 (实际的)
研究记录更新
最后更新发布 (实际的)
上次提交的符合 QC 标准的更新
最后验证
更多信息
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